Here our physio Nicola takes you through one of her clinical interests – women’s health in exercise!
This blog will briefly look over and hopefully bring to your attention the commonality and issue with urinary stress incontinence – or in simple terms, “peeing your pants” a little – whilst exercising and lifting weights. 1 in 3 women will experience some form of stress incontinence in their lifetime, and this doesn’t have to be following having a baby.
Stress incontinence should be something that we are all aware of if we are involved in any form of exercise (which I hope every person is!) and you should know that it isn’t a normal thing, and that there are ways to improve or change it.
Stress incontinence occurs when the pelvic floor, which is the sling of muscles and connective tissue sitting at the bottom of your tummy and pelvis, is not doing its intended job well enough. A nice healthy pelvic floor should be able to hold up to the pressure that you build up in your body, which would be created normally by bracing or breath holding (this is what we call intra-abdominal pressure). This pressure build happens when we skip or set up to brace during a heavy lift. When there is problem and the pelvic floor cannot match the pressure pushing down on it some of the following issues can develop including:
– The need to pee urgently and frequently
– Actually peeing or defecating in your pants when exercising
– Passing wind
– In more major cases, a pelvic prolapse
When we lift heavy weight or put a lot of pressure on our pelvic floor, for example when we skip or lift something heavy from the ground, the pelvic floor muscles need to work and counteract this force. If we create more pressure than what we can control then something has to give – and in the case of stress incontinence this is the leakage of urine from failure of the pelvic floor.
We actually need to produce an increased pressure in our body when we go to skip, jump or move something heavy because in this way we give our body a stable base to work off. However, this should not be greater than our pelvic floor muscle capacity. There can be many causes for why this may be the case, and it is important to be able to identify what might be causing or driving the problem in order to know the correct ways to target treatment approaches (remember, this condition can be changed!).
Some situations that can be lead to more risk of pelvic floor weakness include:
– Pregnancy
– Certain postures
– Habits
– Lack of exercise OR exercise overload
– Poor breath holding
– Poor technique and movement mechanics
It is worthwhile looking at some of these above factors if you are experiencing or have suffered stress incontinence whilst exercising. The good news is you can do something about this issue. This should start with seeing a women’s health professional (for example a women’s health physiotherapist, or your GP) and may involve an initial pelvic floor exam to assess its function. Then you can start working on breaking down technique and moving mechanics before building back up to heavy weights.
One theory that has been proposed to help overcome this ‘leakage of pressure’, is to think about spreading the pressure evenly around through the body before we do a heavy lift or a high volume of continuous work involving an external weight. Taking a breath in before a lift and thinking about spreading this load evenly through your back and core before starting your lift. In some cases, pelvic floor activation and strengthening is appropriate; for others, knowing how to relax and control the pelvic floor better is more critical. Hence the importance of personalised assessment and advice.
You are only as good as your weakest link and for some of us this is our pelvic floor…
Here at Stack St Physio we would love to help anyone who may have questions about their loading amounts and exercise technique if you are having any issues with urinary stress incontinence. This would include a treatment plan looking at lifting and moving technique/mechanics, breathing and load management. If you are dealing with stress incontinence issues, problems in daily life (not just exercise) or severe leakage incontinence it may be wise for you to seek an assessment with a women’s health physiotherapist for a pelvic floor assessment (Worth noting that if you require an internal pelvic exam, we would need to refer you to a dedicated women’s health and continence physiotherapist). If you have any questions regarding this topic and whether you would be suitable for treatment at Stack St Physio, or better suited to see a women’s health physio first, feel free to drop us an email on hello@stackstphysio.com.au or call the clinic on 0421 195 553. I hope that this information has been helpful to you!
Nicola Rutty | Physiotherapist
December 2019
References:
For those interested in some further detail and discussion surrounding this issue, check out the blog posts by the well known pelvic floor physio Antony Lo over at http://physiodetective.com/blog/pelvic-floor/
Here’s a research article for the nerds: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711374/
